An 8 0 year old male i s brought to the emergency department after a syncopal event. He is hypoxic and has a waxing/waning consciousness. The decision is made to intubate the patient as he is not able to protect his airway and will likely go into cardiac arrest without the assisted ventilation. He is successfully intubated and thirty minutes later his grandson arrives with an advance directive signed by the patient indicating that he does not wish to be intubated. Which of the following is the most appropriate step?

A) Extubate the patient and provide supportive care
B) Attempt to contact the patient's spouse as she would be the primary decision maker
C) Utilizing substituted j udgment, maintain the intubation
D) Continue the intubation for now, as the pain of the procedure, the intubation itself, has already happened
E) Maintain the intubation until a family conference can be scheduled

Answer given is E. but my doubt is : Based on what they intubated patient on the first place? 2nd if patient consented before intubation then grandson's directive or having family conference is for what?

I think it should be A....PT had waxing waning conscious when intubated...then advance directive is produced duly signed ...it holds more importance ..it should be honored...no need for a family conference..directives are clear

I'm not sure which version you have, but here's the answer/explanation given in the book. For those who say 'a' is the right answer, do you seriously think the answer to an ethics question is going to be to remove a tube and let the patient die? how old is the advanced directive? what if something has changed that made the patient revoke it verbally before this happened? in real life, would you really just pull the tube out without question???

Answer:
D - Maintain the intubation until you've have a chance to speak with his family

Explanation:

Although the patient has made his wishes clear, families can often provide insight into whether or not the patient would have actually wanted to maintain his DNI order. For instance, he may have recently responded well to chemotherapy and had a sudden change in health that has made him want to prolong his life, and has communicated this to his family, but has not yet reflected it in his official end-of-life documents. To extubate and allow him to die would preclude this discussion from ever taking place – it would be most appropriate to gather the family and allow them to verify that this is what he would have wanted.

While it is inappropriate to supersede an advance directive, in this case the directive was not known about beforehand – in no way should you automatically withdraw the tube and allow the patient to die without speaking to his family.